Sequential versus Alternating Regimens in the Treatment of Advanced Breast Cancer

Giachella, Omar Fernández; Gálvez, Carlos; Rufino, Carlos; Rufino, Adelina; Morera, Federico; Jovtis, Silvia; Cervellino, Juan C.; H, Muro; Crego, Hugo; Marino, María Picciola; Blajman, C.; Iparraguirre, Gladis; Castagnari, Aldo; Ivulich, Carlos; Bianchi, Roberto; Pensel, Raúl; Breier, S.; Bruno, Miguel; Dýaz, Beatriz; Pasccon, Graciela; Larravide, Alfredo; Cardoso, C.; Carlevari, Jorge; Chiesa, Gerardo; Colombini, Enrique; Martinez, J.; Rao, Francisco; Chirino, Miguel Angel; Núñez, Beatriz; Osuna, Alicia; Savulsky, Claudio; Longarte, Adrián; Graizer, Héctor; Fleischer, I; Villalba, J.; Federico, Cristián; Hansen, Ernesto Pasini; Lévy, Daniel; Hannois, Adrián

doi:10.1177/030089168907500211

Cited by 4 publications

(1 citation statement)

References 13 publications

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“…Two hundred and fty patients were randomised in a three-armed study comparing EC therapy followed by CMF (Arm A) vs AC alternating with CMF every second course (Arm B) vs EC alternating with CMF (Arm C) (176). A non-signi cant trend of better response was noticed in arm A and for survival in arm C (176).…”

Section: Sequential ×S Alternating Polychemotherapymentioning

confidence: 99%

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

150

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A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This synthesis of the literature on chemotherapy for breast cancer is based on 233 randomised studies, 9 meta-analysis of randomised studies, a population-based cohort study and 18 overviews/retrospective analyses including a total of 155,243 patients. The conclusions reached can be summarised into the following points: Adjuvant treatment-- There is solid scientific support from randomised studies that adjuvant polychemotherapy at 10 years will result in an absolute mortality reduction for patients younger than 50 years by 12% for node positive (34% relative mortality reduction corresponding to an estimated median survival prolongation of several years) and 6% for node negative patients. For women aged 50 to 69 years, the corresponding figures for node positive and node negative patients are 6% and 2%, respectively (approximately 11% relative mortality reduction). Anthracycline-containing combinations result in an absolute survival benefit at five years of 3%, compared with non-anthracycline based polychemotherapy. There are indications that the taxane paclitaxel may further improve the survival compared with anthracyclines. However, the limited data preclude conclusions for the routine care. The addition of tamoxifen to chemotherapy further enhances the survival benefit for receptor positive subgroups. The roles of more dose-intensive regimens, including high-dose therapy with stem cell support, are presently studied in randomised investigations. The data presented so far are conflicting but they do not in general support high-dose therapy. Quality of life, based on analyses of randomised studies, demonstrate that adjuvant polychemotherapy has an initial detrimental effect, but long-term follow-up of treated patients demonstrates no impairment of quality of life compared with untreated patients. Polychemotherapy in standard doses should be offered to premenopausal node positive patients, and the corresponding postmenopausal group with a receptor-negative breast cancer and to node negative patients with high risk factors. Polychemotherapy should be combined with tamoxifen to all patients with receptor-positive tumours. Due to a need of more knowledge in this field, patients should be included in investigational protocols. Locally advanced breast cancer-- Based on current knowledge, treatment of patients with locally advanced breast cancer should include neoadjuvant/preoperative polychemotherapy since there is evidence from controlled studies that such therapy will statistically significantly increase the number of patients who can be offered breast-conserving surgery. Indirect comparisons also demonstrate survival improvements, but the scientific support is equivocal. Metastatic breast cancer-- The median survival for patients with metastatic disea...

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Section: Sequential ×S Alternating Polychemotherapymentioning

confidence: 99%

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

150

View full text Add to dashboard Cite

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Cisplatinum-Based Alternating Non-Cross-Resistant Chemotherapy as a First-Line Treatment in Metastatic Breast Cancer. A Phase II Study

Kolarić¹,

Tomek²

1990

Tumori

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Exposure to multiple non-cross-resistant drugs should increase cell kill and the chance of achieving more complete and partial responses. Our earlier study in breast cancer showed that second-line CAP (cyclophosphamide, adriamycin, cis-platinum) treatment was not cross-resistant to the CMFVP (cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, prednisolone) regimen and produced a 51% response rate. These facts initiated a phase II study which used an alternating CMFVP/CAP regimen. Altogether, 49 patients entered the study and 45 were evaluated (greater than 2 cycles). The CMFVP regimen consisted of cyclophosphamide (200 mg/m2 on days 1, 2, 3, 4 and 5), methotrexate (30 mg/m2 on days 2 and 4), 5-fluorouracil (500 mg/m2 on days 1, 3 and 5), vincristine (1.4 mg/m2 on days 1 and 5), and prednisolone (40 mg p.o. on days 1-5), and was alternated with the CAP schedule (300 mg/m2 cyclophosphamide on days 1, 3 and 5, 50 mg/m2 adriamycin on day 1, and 30 mg/m2 cis-platinum on days 1, 3 and 5). Overall response was high, and 37 patients out of 45 responded (82%), with a 28% CR rate (13/45). A particularly high response rate was observed in soft tissues (86%, 18/21) and visceral organs (84%, 16/19). Only 1 patient progressed (3%). The duration of remission was 4-21+ months (median, 12 months). Six of 13 CR patients were still disease free 15 months after the treatment was stopped. The duration of survival was 5-25+ months (median, 15+ months). Toxicity was moderate (myelosuppression in 53% of patients, mainly grade I-II; stomatitis in 11%, except for 100% alopecia and 90% nausea and vomiting). One drug-related death (bone marrow aplasia) was recorded. The high antitumorigenic activity of the alternating regimen used is encouraging and may call for a randomized study for the ultimate evaluation of this treatment approach.

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